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You Are Going To Be A Terrible Doctor

uncreateThe further you get in medical school, the more horror stories you hear about students who are told by professors – sometimes in ward rounds, sometimes during exams – that they will “never be a good doctor”. I have never been told that, if only because they know that with my political background, I will have them in the Dean’s office quicker than you can say “bad student”. But they’ve thought it.

What I don’t understand is WHY doctors in training hospitals seem to have this tendency to be so incredibly harsh on students. I understand being strict. I understand enforcing discipline. But this is a half-baked lesson that never reaches its full effect.

A student struggles to fully open the cusco speculum. A student forgets the causes of delirium in an elderly patient. A student struggles to place a catheter. A student reaches the wrong diagnosis. A student cannot remember the correct dosage-adjustment for certain medications in renal failure. 

Students do stupid things. That’s why we are students. Frankly, medical students have a lot less room to do stupid things than other students. Sometimes we make silly mistakes. Sometimes we just forget. And yes, we should remember more. And yes, we should think more clearly. Be less clumsy. Practice more.

But why tell a student, “You are going to be a bad doctor”? I’ve noticed this is a trend among senior medical students too, gossiping about what bad doctors their colleagues or juniors will be. There is a story of a student who had an awful nickname, boiling down to “stupid and inefficient”. He is now an excellent doctor. But he is also quite mean and antisocial. The students and doctors who gave him that nickname contributed to that. Because, you know, bullying is so incredibly mature. And adult-bullying is really what it comes down to.

Considering these things usually happen in the clinical years (i.e. more than two years into medical school), such a statement is unlikely to encourage the student to leave the career now. Too much time spent, too many student loans accrued.

They’re going to continue. And they’re probably going to go on to become doctors. So instead of telling them they are going to be crappy doctors (and make them more miserable, despondent and inclined to fail), why not prevent that reality?

“I see you are still struggling with the speculum. Have you practiced in the skills lab? Yes? Well here, let me guide you. Take a deep breath and relax.”

“Oh, delirium in the elderly is not really that difficult, here’s a handy mnemonic for you.”

“Here, let me hand you the equipment for the catheter so that you can focus solely on its placement. You can learn to do it all yourself with the next patient.”

Why? Because

a) They’re teachers. If they don’t want to be teachers, get a job at a non-teaching facility. There is no shortage of jobs for doctors, at least not in South Africa

b) Medical students will be their colleagues one day. So they can either be annoyed by bad doctors (whom they effectively helped create), or have the opportunity to work with good colleagues, whom they also helped create.

By all means: be strict with students. Give them the marks they deserve. But never criticise without explaining the reason, and helping them to correct their error. Education 101, right?

I may end up working or researching in medical education, because the flaws in medical schools bother me so much. I feel like we are letting our students down – I feel let down. There are good Professors – I have even encountered some of them. I just wish the majority could be like them.

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5 thoughts on “You Are Going To Be A Terrible Doctor”

  1. This is exactly why I want to teach! To reverse some of the awfulness out there still in medical culture (or at least be another person who encourages the good stuff).
    I went to an interesting talk today about culture in medical errors and how we are trained to hate and fear failure so badly that we avoid fixing it because that would mean admitting it. The speaker linked a lot of this back to the fear culture we exist in and the worries about being a “bad doctor” because we weren’t consistently taught to just learn from mistakes.
    Great post!

  2. This article is just what I needed!. I’m a second year student, and of course not an intern yet. Not much experience in interaction with patients except for bed teaching session. But I had so much fear regarding ‘how good I could be’. This is post really calms me down. Thanks! Keep writing!

    1. Aw, I’m glad I could help! I hope that when you start clinical rotations, you will have wonderful teachers. I think a lot of being a good doctor comes down to willpower. Not all, but a lot. Good luck on your journey ahead!

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